Why does my gum hurt years after wisdom tooth removal?

wisdom tooth removal
After wisdom tooth removal, everything should be back to normal. Swelling and pain should gradually decrease, and your gums will return to their normal appearance within a few weeks.

If pain persists longer than expected, you need to visit your dentist. Many oral and facial conditions can cause this type of pain. Some forms may be constant and persist for weeks or months or return periodically with the same symptoms for years.

Only a professional examination can determine the exact cause and the appropriate treatment for you.

Understanding the origin of pain that comes from the mouth

jaw innervation
Pain is typically a response of our body to aggression or an injury. It occurs after the stimulation of certain receptors called nociceptors. These are nerve endings found in the skin, superficial tissues, and all organs. They can transmit nociceptive information to the brain which interprets it as pain.

The nerve responsible for oral pain is called the trigeminal nerve. Depending on the type of the injury, the pain can be localized, diffuse, moderate, or severe.
The nociceptive receptors in the mouth can be stimulated by injury or direct aggression by infection such as caries, gum disease, dental abscess, or trauma.

In some situations, pain can occur in the mouth without any visible damage or injury. These types of unexplained pain is caused by nerve damage, referred to as "neurogenic pain".

Psychological factors such as anxiety and depression may also be involved, aggravating the pain sensation.

The possible causes of pain that occur years after a wisdom tooth extraction

Pain that suddenly appears years after a wisdom tooth extraction can have different meanings.

It is not necessarily related to the extraction procedure. Certain dental conditions such as gum disease, apical periodontitis, and pulpitis affecting other teeth can cause pain to spread throughout the jaw, including the extraction site.

In other less common situations, a nerve may be injured during the procedure, resulting in a tingling or burning sensation.

Among the possible causes of the pain that appears several years after a wisdom tooth extraction:

Dental cavities or fractures in neighboring teeth

tooth layers
Cavities affect the hard tissues of the teeth, including the enamel, which is the outermost layer of the tooth, and the underlying dentin.
If left untreated, cavities will continue to progress toward the pulp where the nerves and blood vessels of the tooth are located.

When a fracture occurs, it creates an opening for bacteria to enter the pulp of the tooth. Once inside, these bacteria multiply and lead to an infection.

The condition in which the pulp is affected is called pulpitis. It is characterized by intense, sharp pain that can spread to neighboring teeth, jaws, temporomandibular joint and ear, making it difficult to pinpoint the origin of the pain.

Therefore, a distant infection in your mouth can spread even to a well-healed extraction site. It is necessary to rule out this possibility before looking further.

Gum disease

advanced stage of gum disease
Gum disease includes gingivitis and periodontitis, which are inflammatory conditions of bacterial origin.
When plaque builds up, it irritates our tissues and causes bacteria to proliferate. As the bacteria interact with the immune system, the tissue surrounding the teeth becomes damaged.

The bone and gums will gradually pull away from the teeth, causing sensitivity and tooth loss. In extreme cases, an acute infection can occur, leading to a gum abscess.

The most common symptoms of gum disease are:
  • Redness and swelling of the gums.
  • Bleeding when you eat or brush your teeth.
  • Gum sensitivity.
  • Gingival recession and tooth loosening.
  • Pus discharge around the teeth.
  • Bad breath.
  • Teeth shifting leading to an improper bite.

To effectively treat gum disease, it is important to address the underlying cause. This can be achieved through proper oral hygiene, such as regular brushing and flossing, as well as professional dental cleaning to remove plaque and tartar, the primary culprits of gingivitis and periodontitis. Your dentist may also recommend a mouthwash and an antibiotic to fully eliminate the infection.

Muscle and joint pain

jaw muscles and joints pain
Another potential cause of your pain is temporomandibular joint disorder (TMD). It involves the chewing muscles and the joint that connects the jaws to the skull.

TMD can cause pain that extends to the jaws and teeth area. It can mimic the symptoms of a toothache, leading to confusion about the true source of the pain.

Symptoms of TMD may include:
  • Pain or tenderness in the jaw, face, neck or around the ears.
  • Difficulty opening or closing the mouth.
  • Increased pain when chewing.
  • Teeth grinding.

Residual cyst of the jaws

Oral cysts are a common condition that can affect bones or soft tissues. They are fluid-filled cavities that grow slowly and silently for years without causing pain.

Most oral cysts are tooth-related and occur inside the jawbone. One of them is called the residual cyst, which represents 5%.

The residual cyst occurs after a tooth has been removed and evolves slowly without any symptoms. You may feel pain or discomfort only if it becomes large or infected (after years to decades). In this case, the gum becomes red and swollen, associated with a flow of pus.

Sometimes, as the cyst grows, you may feel pressure in your jaw and indefinable discomfort in the neighboring teeth.

Atypical odontalgia

Atypical odontalgia or phantom tooth pain is relatively uncommon, affecting 0.03% to 1% of the population, primarily women after 40 years of age, due to hormonal factors.

Atypical odontalgia is defined as persistent pain in one or more teeth or extraction sites in the absence of any visible injury or identifiable cause. In 83% of cases, it occurs after an oral procedure such as extraction or root canal. The area affected seems healthy, which can be confusing for you and your dentist.

The pain is described as a burning or throbbing sensation, triggered on its own, with variable intensity. But in most cases, It remains moderate and should not prevent you from sleeping.

Over-the-counter painkillers and dental treatments have no effect on pain, which explains the involvement of the entire nervous system.

The causes are still poorly understood, which often leads to unnecessary treatment that only aggravates the condition.

The treatment of atypical odontalgia consists in relieving the pain. The most commonly used medications are tricyclic antidepressants.
The treatment should last several months before gradually decreasing the doses. Improvement may occur a few days to a few weeks after the start of treatment.
In summary, after having a wisdom tooth removed, it is normal to experience some swelling and pain. These should gradually subside within a few weeks. However, if the pain persists longer than expected or if it suddenly appeared several years after the procedure, it is recommended to consult a dentist as there may be underlying oral or facial conditions causing the pain. Only a professional examination can accurately diagnose the problem and provide the appropriate treatment.

  1. Advances in understanding nociception and neuropathic pain https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5808094/
  2. Residual cyst of the jaws: A clinico-pathologic study of this seemingly inconspicuous lesion https://pubmed.ncbi.nlm.nih.gov/33332452/
  3. Atypical odontalgia – pathophysiology and clinical management https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2842.2007.01813.x